PHARM- SAR & perennial rhinitis Flashcards
MOA of 1st gen antihistamines
competes w/ histamine on H1 receptor sites of blood vessels & resp tract
drowsiness, cognitive impairment & anticholinergic effects
ADR of 1st gen antihistamines
how can a pt minimize ADR of 1st gen antihistamines
using it more; usually taken QHS
which is better for congestion– 1st or 2nd gen antihistamines?
1st gen but still not great for congestion
name the two 1st gen antihistamines
diphenhydramine
chlorpheniramine
are 1st gen antihistamine safe in pregnancy? how about kids?
both are safe in pregnacy
diphenhydramine is for over 3yo, chlor is for over 2 yo
indications of nasal corticosteroids
once-daily tx of non-infectious rhinitis
tx & prevention of nasal polyps
compare efficacy of antihistamines & nasal steroids for allergic rhinitis
steroids are highly efficacious for it, more effective than mono-therapy with antihistamines
4 major sx of allergic rhinitis that is controlled w/ nasal steroids
sneezing
itching
rhinorrhea
congestion
does nasal steroid work well for ocular sx?
not really
two possible side effects of nasal steroids
nasal dryness
epistaxis
how should you use nasal steroids? PRN or daily?
daily but there is tolerance with prolonged use
name your 3 nasal steroid
mometasone (nasonex)
fluticasone (flonase)
budesonide (rhinocort aqua)
which of the nasal steroids have no mineralocorticoid/androgenic effect?
mometasone
which nasal steroid reduces intraepithelial eosinophilia & inflammatory cell infiltration?
mometasone
of puff limit with fluticasone
4 puffs/day
for >4 yo
which nasal steroid has water to decrease the drying and irritating effect and is better tolerated
budesonide
2nd gen antihistamine MOA
same as 1st gen but also works in GI tract
how does 2nd gen ADR compare w/ 1st gen
2nd gen has less sedation and anticholinergic effects
which class of meds reduce hypersensitivity rxn
2nd gen antihistamine
indication for 2nd gen antihistamines
allergic rhinitis (but not nasal congestion)
occupational rhinitis
name the 3 second-gen antihistamines
cetirizine (zyrtec)
fexofenadine (allegra)
loratadine (claritin)
only mediation for rhinitis that is okay in kids less than 2 years old
cetirizine (zyrtec)– ok in over 6 months old
which medication is the most sedating of the 2nd gen antihistamines & has the most SE
certirizine (zyrtec)
2nd gen antihistamine age requirements
certirizine (zyrtec): >6 months; >6 yo for adult dose
fexofenadine (allegra): >6yo; >12 yo for adult dose
loratadine (claritin): >2 yo; >5 yo for adult dose
onset & duration of antihistamine nasal sprays
15 min onset
up to 4hrs
ADR of bitter taste, HA, epistaxis, sedation, irritation
antihistamine nasal spray
why are nasal antihistamines 2nd line (3 reasons)
cost
ADR
less effective compared to nasal steroids
name the two nasal antihistamines
azelastine
olopatadine
are nasal antihistamines safe in pregnacy?
they are category C
age requirements with nasal antihistamines
azelastine: 5+
olopatadine 6+
how do anticholinergic nasal sprays work?
they inhibit nasal mucous gland secretions
great for excessive rhinorrhea
mucosal dryness, epistaxis, HA
ADR of anticholinergics
2 indicators for anticholinergic nasal sprays
vasomotor rhinitis
gustatory rhinitis
resolves sx of excessive rhinorrhea ONLY!
pregnancy safety and age requirement for anticholinergic nasal sprays
preg cat B
6+ yo
name the single anticholinergic nasal spray
Ipratropium
which two classes are effective for nasal congestion
intranasal antihistamine
intranasal corticosteroid
all of these 3 sx are covered by all classes except anticholinergics
itching
sneezing
rhinorrhea
name the two leukotriene receptor antagonists
montelukast (singulair)
zafirlukast (accolate)
leukotriene antagonist MOA
prevents release of leukotrienes from mast cells & eosinophils
leukotriene antagonist/Montelukast indications
seasonal & perennial rhinitis
long-term asthma control
exercised induced bronchospasms
ADR of URI, fever, HA, pharyngitis, cough, abdominal pain, neuropsychiatric/suicidality
montelukast
